T1s: Metformin and Type 1

What have your blood sugars been like without the Novorapid?

Did you carb count on the Novorapid? And did you know your ratio of insulin to carbs?

I've been Type 1 for more than 20 years and my doses are small. That's because I'm sensitive to insulin not resistant. I'm glad you've got confirmation that you are Type 1. It's far more common in adults than people realise.

If you are confirmed type 1 (which with a gad positive test, you are) and your numbers are in range on low doses of insulin I can't see any reason why you would take metformin (which is designed to assist with insulin resistance) because maintaining in range numbers on low doses suggests you are insulin sensitive - I.e. The opposite of insulin resistant!

I think it's worth seeking clarity from your consultant on the reasoning for his advice, because on the face of it, it doesn't make that much sense.

It still seems strange to me as if you were insulin resistant you'd need higher doses of insulin not tiny ones. Never mind though as at least you have the answer now

If you're unsure about your insulin, then it would be best to check with your consultant. But if you're confident and can carb count, then I presume you'd just go back to what you were doing before.

Do test lots though just to make sure your BS is ok.

Please can we get back on topic. The OP has asked a question to other Type 1s as she has now been confirmed as being Type 1 herself.

There are many benefits to taking metformin for type1s. I would ask your consultant if it is needed in your case. It can help with maintaining a healthy weight and I have seen arguements for type 1s to be perscribed metformin because of the cardiovascular protective effects. On the flip side, metaformin can have unpleasent side effects and many people would argue why take a drug if you don't absolutely need it. Your consultant may have a reason for continuing with metformin. I would ask. Also (and people may disagree) it seems like your insulin regime is still more like a type 2 (i.e. mainly basal). Generally speaking your basal insulin should only be 1/3 to 1/2 of your total daily insulin requirments once you have finished your honeymoon phase. I suspect that you will need to increase your the bolus insulin (novorapid) as you loose your ability to make insulin as the honeymoon period ends. But this may very gradual and take time (2-3 years in my case). Currently if you are getting good control why change? It would be worth you asking to attend a DAFNE course to learn how to adjust your insulin and do a basal test. Good luck xx

Flakey Bake said:

Generally speaking your basal insulin should only be 1/3 to 1/2 of your total daily insulin requirments once you have finished your honeymoon phase.

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Why should basal only by up to 50% of TDD? Is there some benefit to those proportions? Or is that just the general guidelines that are put out as starting points?

OP says she's low carbing, wouldn't that explain the proportions to a large degree? If you bolus according to carbs, but you aren't taking on many carbs your bolus is going to decrease at a much faster rate that the basal does (although low carbing might also reduce basal requirements).

@asyarlk If you are concerned that your basal is too high, you could try some basal testing - https://mysugr.com/basal-rate-testing/ - the job of the basal insulin is to keep you steady in the absence of carbs. It does sound like it might be doing a bit of the work of the bolus. But then, that might not be the worst thing in the work if you know you are a grazer and you aren't feeling forced to eat to your insulin.

asyarlk said:

I take between 1-3 units of novorapid a day and around 15-20 units of levemir. I think my consultant thought that I wasn't type one and just insulin resistant and that's why he prescribed Metformin. I do carb count, my ratio is 1u:20g but sometimes I can eat a packet of minstrels and not go over 6. It's a bit hormonal I think! Diabetes is not easy!!

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Hi, its a bit odd your consultant even thinking you have a particularly low insulin dose. As a long time Type one my dose is similar to or lower than yours on 120 plus carbs (under 18 iu TDD at moment), and i weigh a bit more than you. total dose was 15 at diagnosis, after a life threatening coma, and on 180 gm carbs. my base rate is tiny most of the day, only time it is more is to cover the early morning. The total has altered a lot over the years, in particular with hormones, and illness - that is one downside i have found with using smallish amounts - illness can put up use more than 50%, you just have to adjust to tests. Other downside if you get to having no insulin of your own is very volatile control , improved with lower carbs and very careful diet, but not easy anyway because of a tendency to hypos. Are you sure your consultant is a specialist in diabetes, or just a generalist - i recall some areas may not have specialists. If so, ask to be referred to a specialist in another hospital, no one has ever suggested metformin for me, best wishes

catapillar said:

Why should basal only by up to 50% of TDD? Is there some benefit to those proportions? Or is that just the general guidelines that are put out as starting points?

OP says she's low carbing, wouldn't that explain the proportions to a large degree? If you bolus according to carbs, but you aren't taking on many carbs your bolus is going to decrease at a much faster rate that the basal does (although low carbing might also reduce basal requirements).

@asyarlk If you are concerned that your basal is too high, you could try some basal testing - https://mysugr.com/basal-rate-testing/ - the job of the basal insulin is to keep you steady in the absence of carbs. It does sound like it might be doing a bit of the work of the bolus. But then, that might not be the worst thing in the work if you know you are a grazer and you aren't feeling forced to eat to your insulin.

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'Generally speaking' - this information was from a guide for diabetes nurse when starting patients on insulin. The guide is for people who I assume are not restircting carbs.

asyarlk said:

This is all very interesting. I'm not looking to lose any weight (8 stone 8lbs, 5 ft 5). I am more of a little but often eater so maybe my Basel is maintaining better numbers rather than the novorapid. My current hba1c is 35. I have wondered why he prescribed metformin - I am seeing him next week so I can ask more. I haven't been brave enough to try it as I don't really know what I am doing. I am thinking that I should reduce my Basel and test like mad!

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It certainly doesn't sound like you fit the criteria for a type 1 metformin.

I thought that metformin was used in cases more so of when needing lots of total daily insulin.. TOTAL not basal only...
If lower carbing you can well need less insulin for daily bolus compared to basal. I was like that for a long time until I started having a smoothie each day. I ate say 2 boiled eggs and fried 100g courgette as my one main meal a day. So was bolusing at far less than a 50/50 ratio at the time.

The things that matter are your levels... before and after meals if they removed bolus..

The other thing is that needing smaller doses could lend impetus that a pump with just quickacting may be better for you...

To me, the less drugs the better but to me metformin is not a long term solution to type 1.... out of the two I would prefer a jab of bolus.. so if I wanted a high carb treat (esp over christmas etc) I could.